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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376616443
Report Date: 01/16/2024
Date Signed: 01/16/2024 02:41:13 PM

Document Has Been Signed on 01/16/2024 02:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LEYVA, LORENA & EFRAIN FAMILY CHILD CAREFACILITY NUMBER:
376616443
ADMINISTRATOR:LORENA & EFRAIN L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 441-4973
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 2DATE:
01/16/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Efrain & Lorena LeyvaTIME COMPLETED:
03:00 PM
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On 1/16/24 at 12:00 pm Licensing Program Analyst (LPA) Gerald Poindexter conducted an unannounced annual inspection. Upon arrival, LPA met with Licensees Lorena and Efrain Leyva. Licensee was provided the Inspection Checklist (LIC 126). The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present in the home were two day care children with one child under 24 months.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include dining room, kitchen, living room, TV room, playroom, and hallway bathroom and backyard. Off limits areas include all 3 bedrooms and garage, which are inaccessible through use of door knob covers. There are no stairs in the home. Licensee has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. Licensee understands that supervision is required at all times during outdoor activities. No body of water was observed during time of inspection.

There is a fully charged fire extinguisher, smoke and carbon monoxide detector that meet requirements and are operational. There is a screened electric fireplace. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children, except for in the bathroom drawer (see page 3). Adequate heating and ventilation are provided and vents are installed high. There is a working telephone/email address. Licensee stated there are NO firearms and weapons in the home.

LPA observed all required postings were posted. Children’s records were reviewed and found to be in order. Staff records were reviewed. Licensee has the required immunizations per SB792. Licensee Lorena’s Pediatric CPR/First Aid is current with an expiration date of 10/28/25 and licensee Efrain’s expires 3/25/25. Licensee’s preventative health practices course was completed, which includes lead poison prevention training. Licensee Lorena’s Mandated Reporter Training Certificate per AB1207 is current and expires 1/21/25 and licensee Efrain’s expires 1/19/25.

CONTINUED ON PAGE 2

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LEYVA, LORENA & EFRAIN FAMILY CHILD CARE
FACILITY NUMBER: 376616443
VISIT DATE: 01/16/2024
NARRATIVE
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Emergency drills are conducted and documented with the last one being on 11/28/22 (see Page 3). Licensee maintains a current roster of the children which LPA obtained during time of inspection. LPA verified that all adults living or working in the home have been fingerprint cleared and associated. LPA reminded Licensee that all unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203. Duty officer number is (619)767-2248.

The licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA conducted child care quality management staff interview with the licensee. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LEYVA, LORENA & EFRAIN FAMILY CHILD CARE
FACILITY NUMBER: 376616443
VISIT DATE: 01/16/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

See LIC809D for deficiencies cited.



Exit interview conducted and report was reviewed with the licensee Lorena & Efrain Leyva. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 01/16/2024 02:41 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 01/16/2024 at 01:46 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LEYVA, LORENA & EFRAIN FAMILY CHILD CARE
FACILITY NUMBER: 376616443

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on LPA observation, the licensee did not comply with the section cited above as there was a loose wooden plank and protruding nails from the wood fence in the backyard, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/30/2024
Plan of Correction
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Licensees say they will repair both areas of the backyard fence -- the loose plank and the protruding nails -- and send photo/video evidence to LPA Poindexter via email by 1/30/24.
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above as over-the-counter aerosols and a prescription ointment were in unlatched bathroom drawers, and atop the toilet, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/16/2024
Plan of Correction
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While LPA was present in the home the licensee, Efrain Leyva removed the items and stored them in a safe location. LPA reminded the licensee that products reading "keep out of reach of children," among other items, should be locked, latched or otherwise made inaccessible. Licensees stated they understood and would exercise care in the future.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 01/16/2024 02:41 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 01/16/2024 at 01:46 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LEYVA, LORENA & EFRAIN FAMILY CHILD CARE
FACILITY NUMBER: 376616443

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observations and review of facility records, licensee has not performed or documented a fire drill every 6 months as required, which poses a potential health, safety or personal rights risk to persons in care. Most recent drill was documented 11/28/22.
POC Due Date: 01/30/2024
Plan of Correction
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The licensees stated they will conduct a fire drill with the children and log the drill no later than 1/30/24. LPA reminded licensee that fire/emergency drill must be conducted and documented every 6 months. The licensee will send a photo of the documentation to LPA via email by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 01/16/2024 02:41 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 01/16/2024 at 01:46 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LEYVA, LORENA & EFRAIN FAMILY CHILD CARE
FACILITY NUMBER: 376616443

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, as she did not possess and maintain the safe sleep logs for 2 of 2 infants in care, C1 and C4, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/30/2024
Plan of Correction
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Licensee state they will obtain or create the required safe sleep log and keep updated as required, for C1 an dC4. They will email updated logs to LPA Poindexter no later than 1/30/24. LPA Poindexter provided copies of safe sleep FAQs to the licensees.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024


LIC809 (FAS) - (06/04)
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